WHO recommendations on antenatal care for a positive pregnancy experience

trimester of pregnancy probably has little or no effect
on preterm birth (2 trials, 1318 women; RR: 0.88, 95%
CI: 0.43–1.78) or perinatal mortality (2 trials, 3385
women; RR: 1.09, 95% CI: 0.71–1.67). No other ANC
guideline outcomes were reported in the review.
Additional considerations
• nNone of the trials in the Cochrane review evaluated
effects of more than one dose of anthelminthics.
Findings from large non-randomized studies
(NRSs) suggest that prophylactic anthelminthic
treatment may have beneficial effects for mothers
and newborns living in endemic areas (143–145):
––
One NRS, including approximately 5000
pregnant women in Nepal with a 74%
prevalence of hookworm infection, reported
a 41% reduction in six-month infant mortality
among women receiving two doses of
albendazole (one each in the second and third
trimesters) compared with no treatment (95%
CI: 18–57%) (143). This study also showed
reductions in severe maternal anaemia with
albendazole.
––
A study from Sri Lanka involving approximately
7000 women compared mebendazole with
no treatment and found fewer stillbirths and
perinatal deaths among women receiving
mebendazole (1.9% vs 3.3%; OR: 0.55, 95%
CI: 0.40–0.77), and little difference in the
occurrence of congenital anomalies (1.8% vs
1.5%, for intervention and controls, respectively;
OR: 1.24, 95% CI: 0.80–1.91), even among the
407 women who had taken mebendazole in the
first trimester against medical advice (145).
• nThe <strong>WHO</strong> manual on Preventive chemotherapy in
human helminthiasis stresses that every opportunity
should be taken to reach at-risk populations
through existing channels (141).
• nCross-referencing other <strong>WHO</strong> guidelines, the
upcoming 2016 <strong>WHO</strong> Guideline: preventive
chemotherapy to control soil-transmitted helminth
infections in high-risk groups recommends that a
single dose of albendazole or mebendazole should
be offered to pregnant women in the second and
third trimesters of pregnancy where the prevalence
of any soil-transmitted helminth infection
(roundworm, hookworm and whipworm) exceeds
20% (140).
• nPreventive helminthic treatment helps to lessen
the burden of other infections, e.g. HIV, malaria
and TB, and contributes to a sustained reduction of
transmission (142).
Values
See “Women’s values” at the beginning of section
3.C: Background (p. 64).
Resources
Preventive chemotherapy against helminthic
infections is a cost–effective intervention. The
market price of a single tablet of generic albendazole
(400 mg) or mebendazole (500 mg) is about
US$ 0.02–0.03 (141).
Equity
Helminthic infections are widely prevalent in povertystricken
regions and control of this disease aims to
alleviate suffering, reduce poverty and support equity
(141).
Acceptability
Affected women are often asymptomatic and may
not perceive the need for treatment. Therefore, the
prevalence of soil-based helminthiasis in a particular
setting is likely to influence women’s and providers’
preferences. Studies of anthelminthic programmes
among non-pregnant cohorts, e.g. schoolchildren, in
endemic areas have shown high levels of acceptability
(146). For women receiving preventive treatment in
endemic areas, worms are often visible in the stools
the day after treatment, and this may reinforce the
value of the intervention. However, where there
are likely to be additional costs associated with
treatment (high confidence in the evidence) or where
the intervention is unavailable because of resource
constraints (low confidence in the evidence) women
may be less likely to engage with services (45).
Feasibility
In a number of LMIC settings providers feel that a
lack of resources, both in terms of the availability
of the medicines and the lack of suitably trained
staff to provide relevant information, may limit
implementation of recommended interventions (high
confidence in the evidence) (45).
Chapter 3. Evidence and <strong>recommendations</strong> 69